Walkers Reap Many Health Benefits.

“I USED To think walking wasn't real exercise," your client confesses. "It's so simple, easy and fun, how could it get me in shape? I joined a walking program last spring to try something new, and I've been walking ever since. I've heard that walking is good for my health, but can it really improve cardiovascular conditioning and prevent heart disease and other health problems?"

Because walking is a familiar, convenient and inexpensive activity, it is one of the most popular types of exercise. People who are intimidated by fitness centers, weight rooms and sports often have no problem going for a walk. Personal trainers and exercise instructors often recommend walking to their clients who are new to exercise. Even if clients do nothing but walk, they will still achieve important health benefits. And many clients get hooked on fitness once they begin walking, and add additional activities, such as strength training, to achieve a more well-rounded program. In this way, walking programs can get people into fitness, and sometimes even into a fitness center.

Health benefits of walking

There are many health benefits of walking, and most accrue whether or not fitness improvements are seen. This indicates that walking at a slow or moderately-slow pace still has benefits, especially if strollers walk for 45 minutes or more per session. And the faster the pace and the longer the distance, the greater the health benefits. In other words, the greater the dose of walking (within reason and as appropriate for a client), the greater the health benefits. These health benefits include the following:

Hypertension control and prevention.
Mild to moderate exercise appears to be even more beneficial than high-intensity exercise for controlling hypertension. Thus, a regular walking program is ideal for clients who are trying to bring hypertension under control. Walking may reduce resting blood pressure by helping people lose weight, reducing feelings of stress, or changing chemical or neural factors that contribute to hypertension.

Improvement in blood lipid profile.
The hours spent walking pay off with positive effects on blood lipid profile. Even when walking intensity is not high enough to cause measurable improvements in cardiovascular fitness (such as improvements in V02max), levels of HDL still increase. A higher HDL level indicates reduced risk of cardiovascular disease.

Prevention of type 2 diabetes.
Increased exercise, including walking, means a decreased risk of type 2 diabetes, the most common form of diabetes. In type 2 diabetes, blood sugar regulation is impaired not from a lack of insulin, as in type 1 diabetes, but because the body's cells are not responding appropriately to insulin present in the bloodstream. In a healthy person, insulin signals the cells to let blood sugar in so that it can be used to make energy, or so that it can be stored. In type 2 diabetes, the cells are insensitive to insulin's signal, and sugar remains in the bloodstream instead of entering the cells.

Exercise improves cells' sensitivity to insulin in several ways. First, it prevents weight gain and obesity, which are leading risk factors for developing type 2 diabetes. In addition, exercise increases cells' glucose uptake through several different pathways, including both insulin-mediated and non-insulin-mediated pathways. Recently analyzed data from the Nurses Health Study from Harvard Medical School found that women who walked for exercise had a lower risk of developing type 2 diabetes than their sedentary peers, even when other important variables, such as body mass index, were statistically controlled.2

Like other studies, this one found a dose-response relationship between walking pace and risk reduction. The researchers found that brisk walking (around 5 METS for about five hours per week) had an equivalent effect to more vigorous exercise. In other words, the researchers concluded that brisk walking and vigorous activity were both associated with similar levels of risk reduction for type 2 diabetes.2 Comparable results have been found for studies of men.

Weight control.
Regular exercise is an essential part of any weight-control program. Because of its convenience and familiarity, walking is a popular activity. The total caloric expenditure counts when weight reduction is the goal, since more calories burned should translate into more weight loss. Low- to moderate-intensity activities, such as walking, are ideal for a less-fit population because they are well-tolerated and can be performed for longer durations, so the calories can really add up. Walking also has a fairly low rate of injury.

Coronary heart disease prevention.
Since hypertension, poor blood lipid profile, diabetes and obesity all increase a person's risk for coronary artery disease, it stands to reason that walking should reduce the risk for coronary heart disease. Several studies have found that brisk walking for three to four hours per week reduces the risk of heart attack and underlying cardiovascular disease in both men and women. For example, researchers working with the Nurses Health Study estimate that walking at a moderate pace for three or more hours a week reduces a woman's risk of heart attack by about 30 to 40 percent.3 Similar results have been found in studies of men.'

Increased bone density and lower risk o f osteoporosis.
Weight-bearing physical activities, such as walking, challenge the musculoskeletal system to become stronger. For most healthy people, walking increases bone density without injuring the joints.

Reduced tension and feelings o f stress.
Many walkers find the easy, natural, repetitive motion of walking to be soothing. Add a good walking buddy, some interesting scenery or good music (if you are on the treadmill), and you have a welcome break in the day for having fun and reducing stress. FM

REFERENCES
1. Hakim, A.A., et al. Effects of walking on coronary heart disease in elderly men: The Honolulu Heart Program. Circulation 100:9-13,1999.
2. Hu, F.B., et al. Walking compared with vigorous physical activity and risk of type 2 diabetes in women: A prospective study. Journal o f the American Medical Association 282:1433-1437,1999.
3. Manson, J.E., et al. A prospective study of walking as compared with vigorous exercise in the prevention of coronary heart disease in women. The New England Journal of Medicine 341: 650-659, 1999.

Barbara A. Brehm, Ed.D., is associate professor of exercise and sport studies at Smith College, Northampton, Mass.

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